Total cost of care differences in National Comprehensive Cancer Center (NCCN) concordant and non-concordant patients with colon cancer.
Authors: Ujwal Sapkota, William Cavers, Shirisha Reddy, Elisea Avalos-Reyes, Kjel Andrew Johnson
Journal: Journal of Clinical Oncology (2022)

3624 Background: National Comprehensive Cancer Network (NCCN) colon cancer treatment guidelines have been developed to standardize and improve quality of care. While studies have shown that concordance to these guidelines improves survival, little information exists regarding the impact of concordance and total cost of care (TCOC). This study aimed to evaluate the economic impact of NCCN concordance in patients with colon cancer versus those receiving non-concordant therapies. Methods: This is a retrospective study of patients throughout the United States with colon cancer at a large national Medicaid, Medicare, and commercial insurer from January 1, 2019 - December 31, 2020. NCCN regimen concordance was identified from pharmacy and medical claims and defined as concordant if the entire prescribed treatment regimen matched an NCCN regimen (Level 1 and 2a); patients not receiving an NCCN recommended regimen were deemed to be non-concordant. TCOC and its cost components were contrasted on a matched population of concordant and non-concordant patients with a ratio of 2:1. To eliminate possible selection bias and differences in baseline characteristics that could affect cost, propensity scores were developed using logistic regression and used to match patients on age, comorbidity, socioeconomic status (SES) index and treatment type (chemotherapy and radiation). Results: A total of 937 patients with colon cancer were included (Medicare n = 588; commercial fully insured n = 149; commercial self-insured n = 200). Beginning with and including the first treatment and for up to 180 days after, the TCOC in the concordant group was significantly less among Medicare patients; a reduction of 33% (a difference of $2,986, p &lt; 0.001) in TCOC per member per month (PMPM) was observed. This cost difference was driven primarily by medical chemotherapy spend as concordant patients spent 26% less (a difference of $1,160, p &lt; 0.001). Concordant patients spent 29% less PMPM than non-concordant patients (a difference of $35, p &lt; 0.001) on Evaluation and Management compared to non-concordant patients. There were no significant differences in Inpatient, Emergency Room and Radiation Oncology costs among all patients (p &gt; 0.05). No significant differences were seen in TCOC among commercial fully insured (a difference of $69, p = 0.99) and commercial self-insured (a difference of $5,413, p = 0.07) patients, likely due to smaller sample sizes. Conclusions: In this study, Medicare patients who received NCCN concordant colon cancer regimens spent significantly less in TCOC than patients receiving non-concordant regimens. These savings highlight the importance of evidence-based guidelines in treatment determinations to optimize the value of cancer care. More extensive studies are needed to assess if these findings translate to commercially insured patients and the long-term economic impact of concordance.